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Medicare Drug Benefit: For Good or Ill?

December 28, 2005

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Two articles appearing in the latest issues of the New England Journal of Medicine draw differing conclusions on the effect of the newly enacted Medicare drug benefit.

A perspective article by Stephen Soumerai, professor in the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care, suggests that the new program may be harmful to the health of the poor, elderly, and disabled, the so-called "dually eligible" beneficiaries enrolled in both Medicare and Medicaid.

The short time frame that dually eligible beneficiaries, currently about 7.2 million people, were given to choose and transition to a new drug formulary -- only six weeks -- raises several concerns, Soumerai writes. This includes the risk that beneficiaries may have difficulty transitioning and navigating the complex system.

"This group of dually eligible beneficiaries are especially challenging to reach and educate about coverage changes," Soumerai writes. He suggests that the transition period should be extended to at least one year, creating a longer "crossover" period where beneficiaries can continue to obtain medication through Medicaid.

Additionally, a potential long-term problem is that these beneficiaries may discontinue use of essential medications because of increased co-payments for drugs in many states. There is also the risk that some essential drugs are now not covered, which could create significant health problems in the future.

An editorial appearing in the same issue of NEJM by Richard Platt, professor and chair of the Department of Ambulatory Care and Prevention, also at Harvard Medical School and Harvard Pilgrim Health Care, says that an unintended effect of the Medicare Drug Benefit could be the creation of the world's most valuable resource for understanding how drugs are used, as well as their risks and benefits, especially among the elderly and chronically ill.

"This will be possible because drug dispensing can be linked to individuals' other health information," explains Platt. Covering more than 40 million people, Medicare data can transform our ability to assess drugs in real-life conditions, particularly in this vulnerable population of beneficiaries, which is often underrepresented in clinical trials.

The lack of systematic collection and analysis of post-marketing utilization and outcomes of medication has delayed discovery of some serious problems, which were only realized when millions of people were exposed.

Therefore, it is important to review patients' full medical records in the small number of cases for which this information makes a critical difference. Two existing programs, one in the CDC and one in the FDA, share features that can be adopted for Medicare data.

Platt states that Medicare data will offer a great opportunity to improve the nation's ability to understand the balance of risks and benefits of drug treatment, and if taken advantage of, there will be increased data about whether drugs are used as intended, whether they have their intended effects, and how risky they are.

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